WORLD EMERGENCY MEDICINE SOCIETIES

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jueves, 22 de octubre de 2015

Fascitis necrotizante

"Necrotizing soft tissue infections (NSTI) include necrotizing forms of cellulitis, fasciitis, and myositis. NSTI’s are rare but deadly deep soft tissue infections associated with tissue destruction, systemic toxicity, and high morbidity and mortality. The estimated mortality rate of necrotizing fasciitis is estimated to be between 25-35%. Necrotizing infections can occur anywhere on the body but most commonly affect the extremities, perineum, and genitalia, while rarely arising on the trunk. Infection requires inoculation with the bacteria, which typically occurs via a break in the epithelial or mucosal surface secondary to trauma, IV drug use, insect or animal bites, or surgery. However, it has also been reported without any known trauma in up to 17% of cases. The rarity of the disease and lack of pathognomonic signs and symptoms early in its course make it challenging to diagnose. However, rapid diagnosis is essential because early surgical debridement reduces mortality and amputation rates.

KEY POINTS

Necrotizing fasciitis may be misdiagnosed as cellulitis due to the benign appearance of cutaneous findings early in the clinical course.

Clues to the diagnosis of necrotizing fasciitis are vital sign abnormalities, swelling, and severe pain out of proportion to cutaneous findings.

If you are suspicious for necrotizing fasciitis, have a low threshold to start broad-spectrum antibiotics and consult Surgery without delaying for advanced imaging, even if clinical score and plain films are unremarkable."